Island mucochrondrocutaneous flap for reconstruction of total loss of the lower eyelid.

The methods usually employed for reconstruction of total lower eyelid loss include (1) tarsoconjunctival flaps from the upper eyelid and skin-graft cover and (2) chondromucosal grafts and local skin-flap cover. We report a technique for coverage of these defects with an island flap involving the full thickness of the ipsilateral nasal wall based on the dorsal (external) nasal vessels, terminal branches of the ophthalmic vessels. The advantages of this method are (1) the main components of the eyelid (skin, tarsus, conjunctiva) are reconstructed in a single short operation, even under local anesthesia, (2) there is one donor area that can be closed primarily without significant deformity, (3) the upper lid remains intact, and ectropion is improbable, and (4) the procedure involves a short hospitalization. As disadvantages we might mention bulkiness of the new eyelid and difficult dissection of the (subcutaneous) pedicle.

An unusual presentation of a metastatic hypernephroma to the frontonasal region.

We report a rare case involving an 85-year-old man who presented with a large metastatic hypernephroma to the frontal sinuses, the base of the nose, and the ethmoid sinuses, disfiguring the patient's face. Frequent but intermittent and mild epistaxis was one of the main symptoms. He had no history of renal malignancy, and even at the time of our examination (18 months after the appearance of the facial tumor) he did not have any symptoms of the primary renal carcinoma (not even hematuria). This metastasis may have occurred through the vertebral plexus of veins that communicate with the great venous plexus of the head and the plexus of the paranasal sinuses. If a metastatic hypernephroma to the sinonasal tract is the only clinical metastasis, as in our patient, a radical excision of the solitary metastasis, together with a nephrectomy, is recommended. Physicians dealing with head and neck lesions should always suspect a metastatic tumor and especially, a hypernephroma.